Suspected Bile Duct Pathology in ROUX-EN-Y Liver Transplant Patients: Lessons Learned From Single-Balloon Enteroscopy-Assisted ERCP

Aims Monocentric retrospective study of the feasibility of single-balloon enteroscopy-assisted ERCP (SBE-ERCP) to diagnose and treat biliary pathology in Roux-en-Y liver transplant patients.

Methods From 2016 to 2020 all SBE-ERCP procedures in liver transplant patients were analysed for indications, technical and clinical success and adverse events.

Results 40 patients (26 males; mean age 43±3 years (range 13-81)) underwent 69 SBE-ERCP procedures. Indications were suspicion of anastomotic stricture (40 %), cholangitis (32.5 %), bile duct stones/casts (20 %), biliary leak (2.5 %), haemobilia (2.5 %) and sepsis (2.5 %). Technical success rate per patient was 85 % (34/40). Failure was due to inability to reach the hepaticojejunal anastomosis. SBE-ERCP was normal in 12/34 (35 %), confirmed anastomotic stricture in 12/34 (35 %), bile duct stones/casts in 6/34 (18 %), indwelling metallic stent in 2/34 (6 %) and biliary leak and bile duct torsion both in 1/34 (3 %). Endoscopic interventions: balloon dilatation (6-9 mm), plastic stent insertion (4-7 Fr), stone extraction, bile duct biopsy and direct cholangioscopy in 1 to 6 SBE-ERCP procedures per patient. Only minor adverse events (self-limiting cholangitis) occurred in 5/34 patients (15 %). Clinical success was measured by the evolution of biliary liver function tests before, 1 day after and 30 days after the last SBE-ERCP procedure. There was a significant decrease in gamma-GT serum levels (345±90 U/L before, 257±73 U/L after and 146±27 U/L after 30 days, p=0.023) and alkaline phosphatase levels (337±70 U/L before, 343±89 U/L after and 198±53 U/L after 30 days, p=0.044), whereas the decrease in bilirubine serum levels was not significant.

Conclusions Endoscopic evaluation of the bile duct system is feasible and safe using SBE-ERCP in Roux-en-Y liver transplant patients, allowing close examination of the anastomosis and the bile ducts. Endoscopic therapy leads to clinical improvement of liver function tests.

Citation Moreels T, Monino L, Dahlqvist G et al. eP372 SUSPECTED BILE DUCT PATHOLOGY IN ROUX-EN-Y LIVER TRANSPLANT PATIENTS: LESSONS LEARNED FROM SINGLE-BALLOON ENTEROSCOPY-ASSISTED ERCP. Endoscopy 2021; 53: S217.

Publication History

Article published online:
19 March 2021